A clinical prediction model for sepsis in chemotherapy-induced neutropenia among children with acute lymphoblastic leukemia: development and validation.
- 1Department of Pediatric Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China.
- 2Department of Pediatric Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China. [email protected].
Abstract
Background
This study aimed to develop and internally validate a nomogram for estimating the risk of neutropenia-associated sepsis in children with acute lymphoblastic leukemia (ALL) and chemotherapy-induced neutropenia.Methods
This single-center retrospective cohort study included 264 pediatric patients with ALL treated at the First Affiliated Hospital of Xinjiang Medical University between January 2022 and July 2024. The cohort was randomly divided into a training cohort and an internal validation cohort at a ratio of 7:3. Candidate predictors were evaluated using univariate logistic regression, least absolute shrinkage and selection operator regression, and multivariable logistic regression. Model discrimination, calibration, and clinical utility were assessed using receiver operating characteristic (ROC) curves, calibration analysis, and decision curve analysis (DCA), respectively. Bootstrap internal validation with 1,000 resamples was additionally performed in the training cohort.Results
Among the 264 patients, 39 developed neutropenia-associated sepsis after chemotherapy. Duration of neutropenia, oral infection, glucocorticoid use, and serum interleukin-6 level were independently associated with neutropenia-associated sepsis and were incorporated into the final nomogram (P < 0.05). The nomogram showed good discrimination, with an AUC of 0.884 (95% CI, 0.802-0.966) in the training cohort and 0.893 (95% CI, 0.770-1.000) in the internal validation cohort. The Hosmer-Lemeshow test indicated no significant lack of fit in either cohort (P = 0.11 and 0.36, respectively). DCA demonstrated potential clinical net benefit across threshold probabilities of approximately 10%-70%.Conclusion
This developed nomogram showed promising performance for estimating the risk of neutropenia-associated sepsis in children with ALL and chemotherapy-induced neutropenia. It may support clinical risk stratification and individualized assessment; however, independent external validation is required before routine clinical implementation.
Related
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- A phase 3 trial of GB-K02 pegfilgrastim biosimilar for preventing chemotherapy-induced neutropenia in breast cancer
BibTeX
@article{zhao2026clinical,
title = {{A clinical prediction model for sepsis in chemotherapy-induced neutropenia among children with acute lymphoblastic leukemia: development and validation.}},
author = {Changda Zhao and Mei Yan and Chuncan Wu and Yingbin Yue and Li Zhao and Yu Liu},
journal = {BMC pediatrics},
year = {2026},
month = aug,
doi = {10.1186/s12887-026-07535-6},
url = {https://europepmc.org/article/MED/43009888},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A clinical prediction model for sepsis in chemotherapy-induced neutropenia among children with acute lymphoblastic leukemia: development and validation.
AU - Changda Zhao
AU - Mei Yan
AU - Chuncan Wu
AU - Yingbin Yue
AU - Li Zhao
AU - Yu Liu
PY - 2026
DA - 2026/08/13
JO - BMC pediatrics
DO - 10.1186/s12887-026-07535-6
UR - https://europepmc.org/article/MED/43009888
AB - Background This study aimed to develop and internally validate a nomogram for estimating the risk of neutropenia-associated sepsis in children with acute lymphoblastic leukemia (ALL) and chemotherapy-induced neutropenia.Methods This single-center retrospective cohort study included 264 pediatric patients with ALL treated at the First Affiliated Hospital of Xinjiang Medical University between January 2022 and July 2024. The cohort was randomly divided into a training cohort and an internal validation cohort at a ratio of 7:3. Candidate predictors were evaluated using univariate logistic regression, least absolute shrinkage and selection operator regression, and multivariable logistic regression. Model discrimination, calibration, and clinical utility were assessed using receiver operating characteristic (ROC) curves, calibration analysis, and decision curve analysis (DCA), respectively. Bootstrap internal validation with 1,000 resamples was additionally performed in the training cohort.Results Among the 264 patients, 39 developed neutropenia-associated sepsis after chemotherapy. Duration of neutropenia, oral infection, glucocorticoid use, and serum interleukin-6 level were independently associated with neutropenia-associated sepsis and were incorporated into the final nomogram (P < 0.05). The nomogram showed good discrimination, with an AUC of 0.884 (95% CI, 0.802-0.966) in the training cohort and 0.893 (95% CI, 0.770-1.000) in the internal validation cohort. The Hosmer-Lemeshow test indicated no significant lack of fit in either cohort (P = 0.11 and 0.36, respectively). DCA demonstrated potential clinical net benefit across threshold probabilities of approximately 10%-70%.Conclusion This developed nomogram showed promising performance for estimating the risk of neutropenia-associated sepsis in children with ALL and chemotherapy-induced neutropenia. It may support clinical risk stratification and individualized assessment; however, independent external validation is required before routine clinical implementation.
SN - 1471-2431
ER -